© 1996 Oxford University Press
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Validation of Questionnaire and Bronchial Hyperresponsiveness against Respiratory Physician Assessment in the Diagnosis of Asthma
* Department of Public Health & Community Medicine, University of Melbourne 200 Berkeley Street, Carlton 3053, Victoria, Australia
** Department of Thoracic Medicine, Royal Children's Hospital Flemington Road, Parkville 3052, Victoria, Australia.
Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital.
Anti Cancer Council of Victoria 1 Rathdowne Street, Carlton 3053, Victoria, Australia.
BACKGROUND: The Tasmanian Asthma Survey (TAS) and the International Study of Asthma and Allergies in Childhood (ISAAC) have used questionnaires to measure the prevalence of asthma in adults and children. We have investigated the validity of these questionnaires by comparing response to questionnaire with a physician assessment of asthma status in the past 12 months.
METHODS: Ninety-three adults were given the TAS questionnaire to complete and 361 children were given the ISAAC questionnaire. Ninety-one adults and 168 children completed bronchial challenge with hypertonic saline. A consultation with a respiratory physician blinded to the results of the questionnaire and bronchial challenge was given to all subjects.
RESULTS: In both adults and children, questionnaires showed high agreement with respiratory physician diagnosis with respect to asthma symptoms in the past 12 months. For the TAS questionnaire the positive and negative predictive values (95% confidence limits) for physician diagnosis for adults were 0.89 (0.68–0.98) and 0.94 (0.86–0.98) respectively. The instrument was also sensitive 0.80 (0.58–0.93) and highly specific 0.97 (0.90–0.99). For the ISAAC questionnaire the positive and negative predictive values for physician diagnosis of asthma in children were 0.61 (0.50–0.71) and 0.94 (0.88–0.98) respectively. Sensitivity and specificity were 0.85 (0.73–0.93) and 0.81 (0.76–0.86) respectively. Compared to the physician diagnosis, the sensitivity of bronchial hyperresponsiveness (BHR) for asthma was low for adults 0.39 (0.21–0.61) and children 0.54 (0.48–0.67) as were the positive predictive values: 0.55 (0.31–0.79) for adults and 0.64 (0.49–0.77) for children. A definition of asthma requiring both a positive questionnaire response and BHR was highly specific but not sensitive for adults 0.37 (0.20–0.59) or children 0.47 (0.35–0.60).
CONCLUSION: Both the TAS and ISAAC questionnaires are valid instruments for the determination of asthma symptoms in the past 12 months.
Keywords asthma, bronchial hyperresponsiveness, questionnaire, validation, physican diagnosis, Australia
Revised 1 November 1995
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